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INTRODUCTION

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  • Professionalism infers the code by which surgeons must conduct themselves amidst grueling training, long hours, fatigue, and stress

  • How will you respond as these forces threaten your ability to maintain yourself as a professional?

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Professionalism infers the code by which surgeons must conduct themselves amidst grueling training, long hours, fatigue, and stressful situations. How will you respond as these forces threaten your ability to maintain yourself as a professional?

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HOW TO DEFINE PROFESSIONALISM

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What is professionalism? The term professionalism encompasses so many ideas and applies to so many different activities that an easy definition is nearly impossible. While the exact definition may elude you, you may be thinking, “I know it when I see it” in the way Supreme Court Justice Potter Stewart so famously described obscenity in 1964. In your experience in the medical field, you can probably think of at least a few examples of situations in which you have seen physicians act in a manner that was unprofessional. The truth is that unprofessional behavior happens often in medicine—this is propagated by physicians and nonphysicians in times of stress, duress, and fatigue. Many great physicians have suffered lapses where they have behaved unprofessionally. The field of medicine is no different, in this regard, from any other field. Because you will inevitably be exposed to unprofessional behavior and may act in an unprofessional way at some point, planning for situations in which lapses may occur and what you will do will help prepare you for facing these challenges. In this chapter, we will explore challenges to professionalism and case examples to think about your role in being professional.

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The landscape of professionalism has changed drastically over the past century. In past eras, the power of the physician was paramount and often unchallenged. More paternalistic medicine was the standard; much less attention was paid to how doctors ought to act with patients, peers, other employees, and physicians in training. Everyone expected doctors would act in what they considered the best interest of their patients, but decisions the doctor made would stand often without question from the patient or anyone else. Generally, no formal curricula existed for many generations for training young physicians to act professionally (except perhaps for remediation or for reentry into practice). Medical students and residents instead learned professionalism based on modeling by training physicians. In some cases, this model worked very well but, of course, it all depends on who is doing the modeling. While we now have curricula throughout the country on professionalism, students and residents still learn the majority of their professional characteristics from their teachers: residents from attending physicians and students from both the attending physicians and their residents. The new curricula on professionalism should help teach students how to look at those behaviors with a critical eye and decide what type of physician and, indeed, person they want to become.

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